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Can guidelines improve referral to elective surgical specialties for adults? A systematic review

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Clarke, Aileen, 1955-, Blundell, N., Forde, I., Musila, N., Spitzer, D., Naqvi, S. and Browne, John, Ph.D.. (2010) Can guidelines improve referral to elective surgical specialties for adults? A systematic review. Quality and Safety in Health Care, Vol.19 (No.3). pp. 187-194. ISSN 1475-3898

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Official URL: http://dx.doi.org/10.1136/qshc.2008.029918

Abstract

Aim To assess effectiveness of guidelines for referral for elective surgical assessment. Method Systematic review with descriptive synthesis. Data sources Medline, EMBASE, CINAHL and Cochrane database up to 2008. Hand searches of journals and websites. Selection of studies Studies evaluated guidelines for referral from primary to secondary care, for elective surgical assessment for adults. Outcome measures Appropriateness of referral (usually measured as guideline compliance) including clinical appropriateness, appropriateness of destination and of pre-referral management (eg, diagnostic investigations), general practitioner knowledge of referral appropriateness, referral rates, health outcomes and costs. Results 24 eligible studies (5 randomised control trials, 6 cohort, 13 case series) included guidelines from UK, Europe, Canada and the USA for referral for musculoskeletal, urological, ENT, gynaecology, general surgical and ophthalmological conditions. Interventions varied from complex (“one-stop shops”) to simple guidelines. Four randomized control trials reported increases in appropriateness of pre-referral care (diagnostic investigations and treatment). No evidence was found for effects on practitioner knowledge. Mixed evidence was reported on rates of referral and costs (rates and costs increased, decreased or stayed the same). Two studies reported on health outcomes finding no change. Conclusions Guidelines for elective surgical referral can improve appropriateness of care by improving prereferral investigation and treatment, but there is no strong evidence in favour of other beneficial effects.

Item Type:	Journal Article
Subjects:	R Medicine > RD Surgery
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Medical referral -- Research, Surgery, Elective -- Decision making, Systematic reviews (Medical research) -- Great Britain
Journal or Publication Title:	Quality and Safety in Health Care
Publisher:	BMJ Group
ISSN:	1475-3898
Date:	8 March 2010
Volume:	Vol.19
Number:	No.3
Page Range:	pp. 187-194
Identification Number:	10.1136/qshc.2008.029918
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	National Institute for Health Research (Great Britain) (NIHR)
Grant number:	SDO/08/1310/072 (NIHR)
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URI:	http://wrap.warwick.ac.uk/id/eprint/2939